The present invention pertains to the management of a bone fracture, and, more particularly, a plate system that is used in a surgical procedure to manage a distal radius or similar bone fracture.
A distal radius fracture is a bone fracture of the radius in the forearm, and indeed, it is one of the most common bone fractures. Because of its proximity to the wrist joint, such a fracture is often referred to as a wrist fracture.
The management of distal radius fractures has evolved through many phases. In the 1950s and 1960s, closed reduction and immobilization (i.e., casting) were preferred forms of treatment. Unfortunately, in a large proportion of displaced distal radius fractures, casting was unable to maintain the alignment of the fragments and the reduction. Therefore, percutaneous pinning was added as an adjunct, and many variations of percutaneous pinning techniques were used.
In the 1980s, the management of distal radius fractures was mostly through external fixation. Many types of external fixation techniques were developed and used, including mobile external fixation systems. In addition to the external fixation, percutaneous fixation was also used in some circumstances.
In the 1990s, the trend shifted toward internal fixation, where a plate was applied to the dorsal surface of the radius. Although this form of internal fixation was generally successful, there were many problems with placement of thick metal plates on the dorsal surface of the radius where there was very little space for a plate. For instance, there were many reports of tendonitis and tendon rupture due to such plates rubbing against the tendons.
In the 2000s, the trend shifted toward placing the plate on the palmar surface of the radius—volar (palmar) radial plating. The palmar surface of the radius is relatively flat and is able accommodate a plate under the thick pronator quadratus muscle that covers this surface. In placing the plate on the palmar surface of the radius, early screws that were utilized were non-locking screws. Later, locking screws were used that allowed for an angle stable fixation of the distal radius fracture, thus providing a very stable construct. Then, in order to address complex intraarticular fractures, variable angle locking screws were designed and utilized. Thus, currently available radial plates have either fixed or variable angle locking screws or pegs in one or two columns on a horizontal segment of the plate, and non-locking or locking bicortical screws on a single central vertical segment of the plate.
Still, the management of distal radius fractures continues to evolve, and it would be desirable to provide a plate system that results in a very stable and robust support, which can be used not only for a distal radius fracture, but also for fractures in other bones.